Rory Carroll on going to Africa for plastic surgery

Once upon a time the only tourists chopped up in South Africa were the victims of crime, but that was before Lorraine Melville had her big idea: scalpel safaris. What better way to satisfy the yearning for beauty and travel than flying to the opposite end of the planet for plastic surgery, followed by recuperation in the privacy of a game park.

Three years after setting up her company, Surgeon and Safari, Melville is taking clients from all over the world, notably Britain, and watching a host of competitors spring into life. Travelling abroad for operations is not new but this latest form has grown so fast as to be dubbed a hedonistic illustration of global supply and demand. The flesh is willing and the rand is weak.

For clients the appeals are obvious. Despite a recent rally, South Africa's currency is feeble compared with the pound, dollar and euro. More of the Britons who spend £200m on cosmetic surgery each year have woken up to the fact that operations in Johannesburg or Cape Town can be a third of the price at home.

A full face-lift, 14 nights at Johannesburg's swanky Westcliff hotel and a chauffeur comes to less than £6,000. For tummy tuck and liposuction the cost is about the same. The puns you get for free: leave the bags at home; get a lift from your holiday; be beauty amid the beasts.

"Please don't say we are cheap. We are less expensive, we are value for money, but don't say cheap," says Melville, after the end of another long day at her Johannesburg office. "We offer the highest quality care, first-world standards with some of the best surgeons around."

In South Africa, chop shops are garages that dismember stolen cars, not dodgy clinics, but the British Association of Aesthetic Plastic Surgeons is not alone in highlighting the risks of medical tourism to poor and underdeveloped countries.

From Asia and eastern Europe have seeped horror stories of botched operations, medical staff not speaking English, and poor facilities. "There is a big difference between 'cheap' plastic surgery and 'good value'. Cheap surgery is the most expensive kind - doing it again to get it right costs you much more in the end," says Wendy Lewis, author of The Lowdown on Facelifts and Other Wrinkles Remedies.

South Africa has avoided scandal but Melville worries that some of her newer competitors may cut corners. Exact figures are not available but at least several hundred Britons were operated on in South Africa last year.

"Our surgeons are top class because early in their careers they got a lot of practise at reconstruction surgery to repair damage done by gunshot wounds and the like. Surgeons in the UK don't have the same opportunities," she says.

Potential clients are sent a medical questionnaire and interviewed about their motivation. Those who want too drastic changes, or too many things simultaneously, face-lift, liposuction, tummy tuck, nose job, are dissuaded by two words: Michael Jackson. Those who expect the operation to transform their lives, find a partner, become happy, are advised it will not.

From the airport, clients are shuttled to a posh hotel, talked through the procedure and often operated on the next day, giving a week or two for bruises to fade and swelling to subside before returning home to (a hoped for) shower of compliments on how well they look after their holiday.

Most keep the operations secret but some are so delighted that they go public. For half her life Kelly Williams, 22, a BBC costume assistant from Surrey, wanted to change the shape of her bottom, but gym, toning tables, electronic pads and clingfilm did not work. A yob shouting "Oi! Big bum" across a Spanish beach hardened her resolve, and through the internet she discovered that liposuction in South Africa would cost £1,700 compared with £2,500 in the UK.

A surgeon injected saline solution and sucked three-and-a-half litres of fat from her buttocks and thighs with a tube. Days later she was viewing wildlife. When the bandages came off after a month the result was not quite Kylie but enough to prompt queries about whether she had lost weight.

Williams celebrated with a £140 pair of jeans from Harvey Nichols. "If I thought I wanted anything else done I'd definitely go back to South Africa because everything went so well. To my surprise I wasn't too sore to go on safari. I don't know if it was just for me but the Jeep had padded seats."

For Nicola Greening, 37, a sales executive from Wiltshire, the priority was thighs, buttocks and wrinkly eyes, a snip at £2,000 compared with £4,500 in the UK. Flights and accommodation cost an extra £2,000 but that added up to a £500 saving and a free holiday for her boyfriend, Steve Cook. "It was fantastic, everything went smoothly. We went because the surgeons came highly recommended and Nicola was delighted with the result," says Cook.

Surgeon and Safari was founded after a failed marriage left Melville emotionally raw, so perhaps it is no surprise that she describes the business of slicing, peeling, stretching and stapling skin in terms of healing, of self-esteem replacing insecurity.

The clients agree. Having your bones mashed and breasts slashed is about empowerment. Shonali Rodrigues, 27, an events organiser from London whose nickname at school was "snozz", returned from South Africa with a smaller, straighter and more defined nose as well as the memory of bouncing in a Land Rover with a woman called Sally who wanted breast implants.

"It was a great relief to have the operation. It's quite a traumatic thing to happen to your face and I was a bit woozy for a while but I was fine on the safari, I was sitting all the way."

Rodrigues was attracted by the savings - even after the flights and hotel it was cheaper than the UK - and having wildlife rather than London commuters seeing the bandage on her nose. "I'm not surprised at how popular these holidays are. Society has become more aesthetically aware, and if people want something they are expected to go and get it."

A fifth of Surgeon and Safari's clients are men, a proportion its founder expects to grow fast. It turns out that only a minority of clients go on safari, some go shopping, some lounge by the pool, some go straight home, but a touch of exotic alliteration does wonders for branding.

Clinics around the world report growing numbers of medical tourists. Dr Arnoldo Fournier says Britons and Norwegians have recently followed Americans and Canadians to his surgery in Costa Rica. He reels off the fringe benefits: "We are a peaceful place, we do not have an army. We are home to roughly 4% of all flora and fauna on the Earth. We have seven volcanoes."

People come to Brazil, says Dr Ewaldo Bolivar de Souza Pinto, mainly for face-lifting and rhinoplasty, but they could have so much more: "Last year a Brazilian surgeon was awarded the prize for best hair transplantation results in the world."